Monday Medical: Antibiotics not for viral illnesses

Steamboat Springs  During this time of year, many Steamboat Springs residents are dealing with sinus congestion and pain, sore throat, post-nasal drip, cough, chest tightness, fever, chills and/or body aches. In other words, they are just plain feeling lousy.

Because Steamboat is a busy tourist destination, most viral illnesses in the United States - and many from overseas - make their way here. Unfortunately, antibiotics will not help these illnesses and can even cause harm.

Colds, the flu and most coughs and sore throats are caused by viruses. Antibiotics do nothing against viruses. A large body of research and evidence-based guidelines emphasize that acute bronchitis and most acute sinusitis cases are not bacterial infections.

Acute bronchitis is a short-term (lasting about two weeks) inflammatory illness involving the large airways in your lungs causing cough without pneumonia. Acute bacterial sinusitis is often dramatic and involves only one side of the face.

Strep throat is the only common type of sore throat caused by bacteria, and most health care providers can rule it out quickly with a simple test.

Please consider the following when you think you may need antibiotics:

Every ear infection does not require antibiotics. According to a joint practice guideline by the American Academy of Family Physicians and the American Academy of Pediatrics, most ear infections in children older than 2 years old get better on their own and are not helped by antibiotics.

Colored sputum or nasal discharge usually does not mean a bacterial infection. Color is a poor predictor of a bacterial infection. Many viral illnesses will cause colored discharge. However, in some patients with chronic lung conditions, such as emphysema, a change in sputum color or production may indicate the need for antibiotics.

Chest tightness usually is not a sign of pneumonia. Many viral illnesses and reactive airway disease can cause chest tightness.

Antibiotics will not help most sinus pressure or pain. Most viral illnesses, and allergies, can cause inflammation and mucous accumulation in the sinuses (sinusitis).

A cough that lasts for more than a week does not mean you have pneumonia. The cough from a viral illness sometimes can last three or four weeks.

Just because a person got better with antibiotics last time, the antibiotics may not have helped. The natural course for any viral illness is to get better with time. Taking an antibiotic may not have sped up recovery any faster than taking a sugar pill.

Why not just take antibiotics in case they might help? In addition to causing allergic reactions, unnecessary antibiotic use can harm people in other ways. The over-use and incorrect use of antibiotics has fueled a bacterial arms race and the rise of antibiotic-resistant bacteria.

Of particular concern is the growing incidence of methicillin-resistant staph aureus. MRSA is resistant to almost every antibiotic and usually requires intravenous medication. We have begun to see resistance to even our most effective antibiotics, such as Levofloxacin (Levoquin).

Another reason to avoid the unnecessary use of antibiotics is they can kill the good bacteria that live in balance in our bodies and help us to digest our food. Sometimes an unwanted bacteria, such as Clostridium difficile, can then overgrow. The result can be diarrhea, cramps, food intolerances and other intestinal symptoms. Many women know antibiotic use can cause vaginal yeast infections.

Antibiotics will do nothing for most coughs, sore throats or sinus congestion. Most health care providers are following the rule "do no harm" when they tell a patient that antibiotics will not help their respiratory illness.

The unnecessary and incorrect use of antibiotics is putting all of us at risk. Some day you may have a serious infection that will not respond to antibiotics. Help yourself and fellow Yampa Valley residents by asking for and using antibiotics only when indicated.

Brian C. Harrington, MD, MPH is a board-certified family physician at Yampa Valley Medical Associates, P.C., and provides comprehensive health care to children and adults.

Comments

What would be your response to the long-term use of antibiotics (3-6 months/macrolides) in patients diagnosed with Chlamydia Pneumonia (respiratory bacteria, not to be confused with STD Chlamydia Trachomatis)? If, that is, any docs in this community bother testing for it in patients with chronic bronchitis, sinusitus, laryngitis, etc. which may actually be caused and/or exacerbated by CPn? And, unlike Viral Pneumonia, chest x-rays are meaningless with CPn so if diagnostic blood tests for it are never conducted, how can you, as a medical professional, "know" the patient is suffering from a virus and not a bacterial infection?

As for the use of quinolones in treating bacterial infection of ANY sort....overmarketed, overused, inappropriately prescribed by docs who don't take the time to understand the wide range of antibiotics, even pushed on patients with cancer as an unproven preventative antibiotic. Instead of pointing to the ineffectiveness of an inappropriately used antibiotic as a contributor to MRSA, why not wash your hands more often, Dr. Harrington? Or, practice any of the items identified here:

DOCTORS are the individuals in charge of the script pad, not patients. If docs can't even understand what antibiotics to prescribe and when to properly do so, how can you expect the public to take on the responsibility? And, if docs don't practice meticulous hygiene habits (per the article on the link above) then who's to blame for MRSA: patients taking a prescribed drug from a medical professional OR the doc who'd rather prescribe an antibiotic than wash up with each patient?

Also, what about the widespread prophylactic use of antibiotics in livestock? Doesn't THAT play a role in bacterial mutation and a growing resistance to antibiotics in treating humans with bacterial disease?

And then there's the wide range of products now available to the public which have been treated with "antimicrobial" chemicals. Toothpaste, soap, outdoor clothing -- maybe even those long johns you bought last season that touts "odor control". Same antimicrobial chemicals that are used to combat bacteria in the hospitals are now widely sold/purchased to/by the public throughout the country. Wonder what the overuse of that crap has done to bacterial mutation and resistance?

Sidenote: household soaps & toothpastes containing triclosan and used with chlorinated tap water = chloroform. I always thought washing dishes was a bit of brain numbing experience...now I can point to "why" it is...

When triclosan was added to Colgate toothpaste quite a few years ago as an antimicrobial, I mailed my tube back to the company and requested a refund. They wrote back, sent the refund, enclosed some coupons, and nastily commented to me that triclosan was not exactly "agent orange" and was approved by the EPA for use in household products. EPA. Yep, it's a pesticide. Bacteria = pest. To be really, really clean we must eradicate all bacteria....NOT! Triclosan enhanced products used with chlorinated water...toxic and potentially cancer inducing. But at least it's not Agent Orange.

I hate it when docs push this issue of asking for/taking antibiotics off on the patients. The issue is huge and patients taking too many antibiotics for whatever reason is only a drop in the bucket of the rain barrel of bacterial disease, bacterial mutation, and antibiotic resistance.

How about we all stop buying antimicrobial household products, the farmers stop shoving antibiotics prophylactically into feed animals, and doctors start washing their hands and changing their coats before seeing a patient? Those 3 items contribute to the vast majority of bacterial mutation and antibiotic resistance in this country. Inappropriately prescribed prescriptions contribute, as well, but are very low on the totem pole of causation for MRSA.

If there's one thing a patient can do to reduce the potential for bacterial infection: insist that your medical providers wash their hands in your presence and turn away any who are wearing a tie (bacteria loves to hop onto a doc's tie!) or have on a soiled lab jacket. If you're already sick when you visit the doc or hospital, why make it worse by exposing yourself to even more bacteria via medical care givers?

I am glad my article sparked your interest. Chlamydia, mycoplasma and pertussis are each bacterial causes of respiratory illness. Some studies suggest that they may present in roughly 20% of patients with persistent coughs. I certainly consider these possibilities when treating someone with a clinical picture that is consistent with them, or coughs lasting several weeks. Contrary to your assertion, just a couple weeks ago I tested a patient for chlamydia. These bacterial agents, if present, respond to relatively short courses of antibiotics. 3-6 months of antibiotics are not indicated or necessary.
Actually, my hands are quite dry and cracked right now because of the frequent hand washing I do. Hopefully most providers follow this cardinal rule to reducing the spread of infection. You are correct. As a group, medical providers do a poor job of adhering to simple, effective ways of preventing the spread of infection. However, poor hand washing has little to do with the development of bacteria resistance to antibiotics.
I fully agree with your points about the indiscriminant use of antibiotics in our society. MRSA is one dramatic example of bacterial resistance, but there are numerous more. Providers, patients and society each have a role in the prudent use of antibiotics. My article, with required space limitations, was an attempt to deal with one facet of this issue. I am a firm believer in providing patients with information to make their own responsible decisions. It would be great if we could get patients and providers alike to be better users of antibiotics.

Thank you for your response, Dr. Harrington. It's good to know that you wash frequently and are sensitive to the components medical professionals bring to the table of fighting bacterial infection and use of antibiotics.

However, we differ on our opinions regarding Cpn and short course treatment of antibiotics. Cpn is highly resistant and prone to frequent recurrence. Short courses of antibiotics may alleviate symptoms temporarily but doubtful they work to eradicate the bugger.

Your article laid out the reasoning quite clearly. Except, that is, the contribution of medical providers to the problem and how patients can protect themselves when seeking medical care.

Blame the victim (patient) mentality is far too prevalent in this society. Doesn't help when papers publish short-sighted articles like this one that fails to grasp the full picture of mutual responsibility. Ugh.